|
|
|
|
|
|
|
PEER-TO-PEER CLINICAL CONVERSATIONS |
|
|
|
|
|
|
Balancing Treatment Intensification and Quality of Life in Elderly Prostate Cancer Patients
|
|
Rana McKay, MD
|
| Rana McKay discusses treating older patients with high-risk and locally advanced prostate cancer. Dr. McKay recommends the Geriatric 8 screening tool, a four-to-five-minute assessment, as a first-line frailty screen, with scores of 14 or below triggering comprehensive geriatric assessment.
|
|
|
|
|
|
|
|
|
|
|
|
|
Testosterone Recovery Dynamics After Short-Term ADT for Localized Prostate Cancer
|
|
Bertrand Tombal, MD, PhD
|
| Bertrand Tombal outlines testosterone recovery dynamics after short-term ADT with radiation therapy. Canadian data show that even a six-month depot LHRH agonist injection leaves 30 to 40% of patients testosterone-suppressed for an extended period.
|
|
|
|
|
|
|
|
|
|
|
|
|
Genomic Classifiers and AI for Personalizing Prostate Cancer Radiation Therapy
|
|
Jason Efstathiou, MD, DPhil, FASTRO, FACRO
|
| Jason Efstathiou discusses the use of genomic classifiers and AI-based tools in personalizing radiation therapy for prostate cancer. Dr. Efstathiou cites NRG-GU009 and GU010 as ongoing prospective trials embedding Decipher® into escalation and deescalation decisions for intermediate and high-risk disease.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The 2026 Advanced Prostate Cancer Consensus Conference
|
|
|
|
|
| How to Treat Older Patients with High-Risk and Locally Advanced Prostate Cancer
|
| Rana McKay, MD
|
| Rana McKay emphasized that treating older men with high-risk or locally advanced prostate cancer should be driven by frailty, comorbidity, life expectancy, and patient preference rather than age alone. She highlighted Geriatric 8 screening as a practical first step and stressed that local therapy, ADT duration, and whether to add an ARPI should be individualized to balance benefit, toxicity, and treatment burden.
|
|
|
|
|
|
| Dissecting mAPM Naïve – What Are Relevant Subgroups Today and in the Future That Are Relevant for Treatment Decision?
|
| Ana Aparicio, MD
|
| Ana Aparicio argued that metastatic prostate cancer should be divided by drug-response biology rather than older clinical labels. She highlighted PSMA-high, BRCA2/HRR-mutated, MSI/TMB-high, and PTEN-loss disease as examples of therapeutically relevant subsets and called for a consensus composite biomarker signature for future trials and treatment selection.
|
|
|
|
|
|
|
|
|
|
|
| How to Test for Relevant Molecular Alterations in mHSPC?
|
| Joaquin Mateo, MD, PhD
|
| Joaquin Mateo recommended that all men with mHSPC who are candidates for treatment intensification should be considered for at least HRR-gene testing, with germline testing for everyone and broader panels if resources allow. He also emphasized that mHSPC is a good time to standardize testing because tissue is closer to diagnosis, ctDNA can be falsely negative in low-burden disease or after ADT, and a practical pathway is comprehensive molecular testing up front with ad hoc biomarker use later in mCRPC.
|
|
|
|
|
|
| How to Select Patients with mHSPC for ADT, an ARPI, and Targeted Therapy
|
| Shahneen Sandhu, MBBS, FRACP
|
| Shahneen Sandhu’s message was that mHSPC should only be selected for ADT + ARPI + targeted therapy when there is a clear biomarker rationale, not just high conventional disease volume. The most relevant current candidates are men with BRCA/HRR alterations for PARP inhibition and PTEN-loss for AKT inhibition, with future selection likely guided by PSMA PET tumor volume, ctDNA fraction, transcriptomics, and co-alteration patterns.
|
|
|
|
|
|
| Which Patients with Synchronous, Metastatic Hormone-Sensitive Prostate Cancer Benefit from Prostate Radiotherapy? STOPCAP Meta-Analysis of Individual Participant Data
|
| Peter Godolphin, PhD
|
| Peter Godolphin reported that prostate radiotherapy benefits in synchronous mHSPC are concentrated in men with less extensive metastatic disease, especially those with low-volume disease or fewer than 5 bone metastases. Across all patients, the main additional benefit was a reduction in symptomatic local events, so selection should balance that against urinary toxicity and quality-of-life tradeoffs.
|
|
|
|
|
|
| What to Expect from Androgen Receptor Antagonist Monotherapy in Terms of Side-Effects and HRQoL?
|
| Fred Saad, CQ, MD, FRCS, FCAHS
|
| Fred Saad’s APCCC 2026 presentation concluded that androgen receptor antagonist monotherapy is generally well tolerated and may preserve sexual function and bone health better than ADT, but it is less effective than combination treatment in advanced disease. Key side effects include gynecomastia/breast pain, fatigue, and hypertension, while overall quality of life appears broadly similar to ADT-based therapy rather than clearly superior or inferior.
|
|
|
|
|
|
|
|
|
|
|
